Impact of Rehabilitation on Readmission Rates in Older Patients with COPD with Disability After Hospital Discharge

This study aimed to evaluate the impact of rehabilitation on readmission rates among older patients requiring nursing care following with COPD following hospitalization for lower respiratory tract infection, focusing on whether initiating rehabilitation within two months post-discharge reduces readmissions. We conducted a retrospective observational study using insurance claim data in Kobe City, Japan, with a population of approximately 1.5 million. We included Patients with COPD aged 65 or older with certified care-need levels under Long-term Care Insurance system in Japan, hospitalized for lower respiratory tract infections and survived alive. Patients were classified based on their functional capacity in Activities of Daily Living (ADL). We used the extended Cox model to consider rehabilitation as time-varying exposure and assess the hazard ratios for readmission, adjusting for ADL. The ADL level was adjusted as a confounder. The survival probabilities were estimated among patients who experienced rehabilitation within two months and those who did not experience rehabilitation. Among 745 patients, 479 received rehabilitation within two months post-discharge, 105 received it later, and 161 did not receive rehabilitation. Participation in rehabilitation was associated with an increased hazard ratio for readmission (HR: 1.63, 95% CI: 1.19, 2.24), compared to those without it. The estimated survival curve of patients receiving rehabilitation within two months overlapped with that of those who did not receive rehabilitation. Rehabilitation following exacerbation in older patients with COPD who have disability may increase the risk of readmission after discharge. Healthcare providers should consider that patients with COPD with severe disability and complex needs may require staged, individualized rehabilitation.